The Union Cabinet on Thursday cleared the Mental Health Care Bill, 2013 that makes access to mental health care a right of all persons. Such services should be affordable, of good quality and available without discrimination, it said. The proposed law decriminalises suicide.

The Bill, in consonance with international laws, has the provision of Advance Directives — described as a progressive and far-sighted step. No person who has recorded an Advance Directive to State that he or she should not be admitted to a facility without consent can be so admitted.

A rights-based Bill also has a provision wherein a person with mental illness can appoint a nominated representative to take decisions for him or her. Under the provisions of the Bill, government has an obligation to provide half way homes, community caring centres and other shelters for mentally ill people. This has been planned under the District Mental Health Programme in the 12th Plan.

In 2005, the National Commission on Macroeconomics and Health reported that 10-12 million or one to two per cent of the population suffered from severe mental disorders such as schizophrenia and bipolar disorder, and nearly 50 million or five per cent from common mental disorders such as depression and anxiety, yielding an overall estimate of 6.5 per cent of the population. The prevalence of mental disorders was higher among women, those who were homeless, poor and living in urban areas, Union Health and Family Welfare Minister Ghulam Nabi Azad told The Hindu.

The new Bill, once approved by Parliament, will repeal the Mental Health Act, 1987, which had vested extraordinary power in the hands of the treating psychiatrists. There was enough evidence of misuse and unscrupulous families collaborating with psychiatrists in addition to badly functional or non-functional Central and Mental Health Authorities primarily because of lack of funds.

Under the proposed new law, there is provision for voluntary admission with supported admission limited to specific circumstances; appeals can be made to the Mental Health Review Commission, which will also review all admission beyond 30 days and free care for all homeless, destitute and poor people suffering from mental disorder. The Bill provides right to confidentiality and protection from cruel, inhuman and degrading treatment, in addition to right to live in a community and legal aid. It bans the electric-convulsive therapy without anesthesia and restricts psychosurgery, Mr. Azad said.

He said the Bill tries to address the needs of the families and caregivers, and the needs of the homeless mentally ill. It provides for setting up Central and State Mental Health Authorities, which would act as administrative bodies, while the Mental Health Review Commission would be a quasi-judicial body to oversee the functioning of mental health facilities and protect the rights of persons with mental illness in mental health facilities.

The HC said it was “absurd” for husband to say it was in the interest of his wife to go in for early HIV detection.

MUMBAI: The Bombay high court on Friday upheld a family court (FC) order rejecting a man’s plea to direct his wife to undergo a medical check-up as he strongly suspected her to be HIV positive. The court said it was “absurd” for him to say it was in the interest of his wife to go in for early detection.

Justice Roshan Dalvi heard a petition by Santa Cruz resident Joel D’Souza (name changed), who met Joan (name changed) through a marriage bureau. Both professionals, they married on December 26, 2009. In June 2010, Joan had typhoid and went to her mother’s place nearby. Thereafter, Joel stopped calling or receiving her calls. On July 7, 2010, he took her call but told her he would not take her back, without explanation. The medical test report of July 7, 2010 confirmed Joan was cured of typhoid and tests included for HIV antibodies.

On July 10, 2010, on reaching her matrimonial home, she found Joel had changed the lock. On October 22, 2010, he filed for divorce alleging impotency/non-consummation of marriage and cruelty. Pending the petition, on March 16, 2011 Joel filed an application praying for direction to Joan to undergo HIV, TB and hepatitis tests along with tests for impotency/failure to consummate the marriage as he suspected she was HIV positive.

In his application before the FC, Joel gave many reasons, including fever, tiredness, body ache, dry cough, diarrhoea, abdominal pain and headache. He said Joan had a bloated abdomen although her face, hands and legs were very thin and due to this she wore long outfits. “On an official website of HIV, it is documented that HIV is medically caused due to accumulation of fat in the stomach,” he stated. He said she spoke in her sleep using the words ‘HIV’ and ‘AIDS‘ and mentioned ‘Jack Dorsan’, who he found on the Internet was in the prostitution business. He said his wife had stored Dorsan’s telephone number and spoke to him on the day of their wedding.

He said she applied lip balm five to six times a day “as the best treatment for Herpes Simplex Virus is keeping the lips moist”. Joan said Joel’s suspicion was “reckless, wild and cruel” and he himself needed treatment.

The FC on May 16, 2012 rejected his application with costs saying, however strong his suspicion, he had to prove the allegations by furnishing evidence so that the court can grant him relief. Joel moved the high court in October 2012.

Joan’s advocate Mini Mathew argued that the July 7, 2010 report confirming she was cured of typhoid was sufficient to hold that it was not necessary to send her for an HIV test. She said Joel had been spreading rumours about her. “These allegations are stigmatizing. Her reputation is ruined,” she said.

Joel’s advocate Uday Warunjikar said, “He caught his wife taking HIV medicines. If she is not suffering from HIV, why is she afraid of the test?” he asked. Justice Dalvi remarked, “I doubt the marriage can be reconciled. Both sides must move for an amicable settlement.” She added, “Why don’t you throw her out in a little respectable way? It will boomerang on you.

MUMBAI: Life in fast-paced Mumbai seems to be taking a toll on its citizens. In just four days after the BMC launched its mental health helpline on May 14, as many as 352 calls were received. Currently, the 24-hour helpline is receiving between 85 and 100 calls a day.

According to the initial data, one-third of the calls to the helpline was from people above the age of 50 and they had issues like depression and irritability. The second highest number of calls was from those aged between 30 and 40 , who were facing anxiety and work-related stress.

Experts say the sheer number of calls on the helpline shows that the mental health of the people in the city is falling. People are looking for a medium to vent their thoughts and this helpline aims to do just that.

Additional municipal commissioner Manisha Mhaiskar said the response has been overwhelming. The BMC will have to eventually increase the number of lines connected to the helpline, she said. “We have appointed three counsellors to work in three shifts. We have also instructed them that in case there is a very difficult case, they should suggest to the caller that he/she should take an appointment in KEM Hospital’s psychiatry outpatient department so that he/she can be given a personal counselling session,”said Mhaiskar. She said they are not insisting that the callers give out their names and personal details.

The helpline, launched by the mayor, will be operated by KEM Hospital’s psychiatric department. To call the helpline, dial: 022-24131212.

GURGAON: There is an acute shortage of doctors in government hospitals of Mewat. Surprisingly, the district with the worst maternal mortality rate and infant mortality rate, there is only one woman doctor available for the whole of Mewat. However, the apathy could be judged by the fact that the gynecologist has joined the health department only about 10 days ago.

The institutional delivery rate in Mewat is 42% implying only 42 out of 100 deliveries take place at hospital. A health official said these deliveries are done by staff nurses in absence of doctors. Sources said the health institutions are in a bad shape with two of the three community health centres (CHCs) at Punhana and Ferozepur Jhirka in the districts are without senior medical officers (SMOs) for a long time. In their absence, medical officers (MOs) have been made incharge of these CHCs.

Moreover, instead of two medical officers at each of 10 primary health centres (PHCs), there is only one medical officer appointed at present, said sources.

At CHC, Nuh, against the staff postings of 12 medical officers (MOs) and one SMO, there are only 3 MOs and one SMO are deputed.

The population of Mewat is 11 lakh and out of that 5.5 lakh alone lives in Nuh. In such a scenario, the medical facilities are too little to provide any kind of service to residents. A health official said the burden could be gauged that there should be one CHC over a population of 1.2 lakh. There is also a shortage of ASHAs (Accredited Social Health Activists) in the district. ASHA, a trained female community health activist from the village itself who work as an interface between the community and the public health system, plays an important role in providing key services to mother and child and spread awareness. A health official informed that out of 1,200, only 500 are available in Mewat.

This is when the criteria of appointing an ASHA was relaxed from class VIII literate to just any woman who can carry basic duties. Even after that we have not been able to fill the postings, the official added.

When contacted, BK Rajora, chief medical officer, Mewat, said, “There is a shortage of doctors, but the government gives priority to their appointment in the district. The problem is that many of them do not join here even after appointment. What can one do in such a scenario? Doctors do not want to come because of basic living facilities in Mewat.”

The government is also providing difficult area allowance to doctors posted in Mewat, Rs 25,000 per month for specialist and Rs 10,000 per month for other doctors.

Rajora added that besides one gynaecologist joining the office, four doctors have been given training in this field and providing emergency services. There are 53 MOs available out of 79. Almost 50% of positions are filled.

‘The issue of point-of-service fees is critical. Anyone who has provided health care to poor people knows that even tiny out-of-pocket charges can drastically reduce their use of needed services. This is both unjust and unnecessary. Countries can replace point-of-service fees with a variety of forms of sustainable financing that don’t risk putting poor people in this potentially fatal bind. Elimination or sharp reduction of point-of-service payments is a common feature of all systems that have successfully achieved universal health coverage.’

World Bank Group President Jim Yong Kim’s Speech at World Health Assembly: Poverty, Health and the Human Future

We stand at a moment of exceptional possibility. A moment when global health and development goals that long seemed unattainable have moved within our reach. A moment, also, when dangers of unprecedented magnitude threaten the future of humankind. A moment that calls us to shed resignation and routine, to rekindle the ambition that has marked the defining chapters of global public health.

A generation must rise that will drive poverty from the earth. We can be that generation.

A generation must rise that will end the scourge of inequality that divides and destabilizes societies. We can be that generation.

A generation must rise that will bring effective health services to every person in every community in every country in the world. We will be that generation, and you—members of this Assembly—will lead the way.

Yes, I’m optimistic. I’m optimistic because I know what global health has already achieved—what you have achieved.

In 2011, global average life expectancy reached 70 years, a gain of six years since 1990. The global child mortality rate has fallen 40 percent in the same period. In the ten years since Dr. LEE Jong-wook announced WHO’s commitment to support countries in scaling up antiretroviral treatment for AIDS, 9 million people in developing nations have gained access to this life-saving therapy. These are just a few of the milestones of recent progress.

I have another reason to be optimistic. I know global health is guided by the right values.

Thirty-five years ago, the Alma-Ata Conference on Primary Health Care set powerful moral and philosophical foundations for our work. The Declaration of Alma-Ata confirmed the inseparable connection between health and the effort to build prosperity with equity, what the Declaration’s authors called “development in the spirit of social justice.”

Alma-Ata showed the importance of primary health care as a model of health action rooted in the community; responsive to the community’s needs; and attuned to its economic, social and cultural aspirations. Alma-Ata set the bar high. But we continue to struggle to provide effective, high-value primary health care to all our citizens. Unfortunately, none of WHO’s 194 Member States has yet built the perfect health care system. We can all get better and we know it.

But in the grand spirit of Alma-Ata, we must focus again on the link between health and shared prosperity. And, this time, we must turn our loftiest aspirations into systems that build healthier, more productive, more equitable societies.

For what Alma-Ata did not do was provide concrete plans or effective metrics for delivering on its admirable goals. In many cases, frontline efforts inspired by Alma-Ata lacked strategy; evidence-based delivery; and adequate data collection. This shouldn’t have been surprising, and I’m certainly not criticizing global health leaders of that time. Indeed, many of the architects of Health For All are my heroes to this day.

Today, we have resources, tools and data that our predecessors could only dream of. This heightens our responsibility and strips us of excuses. Today we can and must connect the values expressed at Alma-Ata to strategy and systems analysis; to what I have been calling a “science of delivery”; and to rigorous measurement. And we must actually build healthier societies.

The aims of universal coverage are to ensure that all people can access quality health services, to safeguard all people from public health risks, and to protect all people from impoverishment due to illness: whether from out-of-pocket payments for health care or loss of income when a household member falls sick.

Every country in the world can improve the performance of its health system in the three dimensions of universal coverage: access, quality, and affordability. Priorities, strategies and implementation plans will differ greatly from one country to another. In all cases, countries need to tie their plans to tough, relevant metrics. And international partners must be ready to support you. All of us together must prevent ‘universal coverage’ from ending up as a toothless slogan that doesn’t challenge us, force us to change, force us to get better every day.

The good news is that many countries are challenging themselves, measuring outcomes and achieving remarkable progress. Turkey launched its “Health Transformation Program” in 2003 to provide access to affordable, quality health services for all. Formal health insurance now covers more than 95 percent of the population. The health reform is one of a bundle of factors that have contributed to Turkey’s health gains. Between 2003 and 2010, Turkey cut its infant mortality rate by more than 40 percent.

Thailand’s universal coverage reform dates from 2001. The program has substantially increased health care utilization, especially among the previously uninsured. And, as of 2009, the program had already reduced by more than 300,000 the number of Thai people suffering catastrophic health care costs.

And let me acknowledge that Thailand launched its universal coverage program against concerns over fiscal sustainability initially raised by my own institution, the World Bank Group. Thailand’s health leaders were determined to act boldly to provide access for their whole population. Today the world learns from Thailand’s example.

Many other countries are also advancing. And the growing momentum for universal health coverage coincides with a new chapter in the global fight against poverty.

Last month, the organization I lead, the World Bank Group, committed to work with countries to end absolute poverty worldwide by 2030. For the first time, we’ve set an expiration date for extreme poverty.

And we know that fighting absolute poverty alone is not enough. That’s why we’ve set a second goal. We’ll work with countries to build prosperity that is equitably shared, by nurturing economic growth that favors the relatively disadvantaged in every society. We’ll track income growth among the poorest 40 percent of the population in every country and work with country leaders to continuously improve policy and delivery, so countries can achieve economic progress that is both inclusive and sustainable – socially, fiscally, and environmentally.

To end poverty and boost shared prosperity, countries need robust, inclusive economic growth. And to drive growth, they need to build human capital through investments in health, education and social protection for all their citizens.

To free the world from absolute poverty by 2030, countries must ensure that all of their citizens have access to quality, affordable health services.

This means that, today as never before, we have the opportunity to unite global health and the fight against poverty through action that is focused on clear goals.

Countries will take different paths towards universal health coverage. There is no single formula. However, today, an emerging field of global health delivery science is generating evidence and tools that offer promising options for countries.

Let me give just one example. For decades, energy has been spent in disputes opposing disease-specific “vertical” service delivery models to integrated “horizontal” models. Delivery science is consolidating evidence on how some countries have solved this dilemma by creating a “diagonal” approach: deliberately crafting priority disease-specific programs to drive improvement in the wider health system. We’ve seen diagonal models succeed in countries as different as Mexico and Rwanda.

Whether a country’s immediate priority is diabetes; malaria control; maternal health and child survival; or driving the “endgame” on HIV/AIDS, a universal coverage framework can harness disease-specific programs diagonally to strengthen the system.

As countries advance towards universal health coverage, there are two challenges we at the World Bank Group especially want to tackle with you. These two areas are deeply connected to the goals on poverty and shared prosperity I described a moment ago.

First, let’s make sure that no family, anywhere in the world, is forced into poverty because of health care expenses. By current best estimates, worldwide, out-of-pocket health spending forces 100 million people into extreme poverty every year, and inflicts severe financial hardship on another 150 million. This is an overwhelming form of affliction for people, as the anguish of impoverishment compounds the suffering of illness. Countries can end this injustice by introducing equitable models of health financing along with social protection measures such as cash transfers for vulnerable households.

Second, let’s close the gap in access to health services and public health protection for the poorest 40 percent of the population in every country. Improving health coverage and outcomes among the poorer people of any country is critical to building their capabilities and enabling them to compete for the good jobs that will change their lives. We have to close health gaps, if we’re serious about reducing economic inequality, energizing countries’ economies and building societies in which everyone has a fair chance.

The issue of point-of-service fees is critical. Anyone who has provided health care to poor people knows that even tiny out-of-pocket charges can drastically reduce their use of needed services. This is both unjust and unnecessary. Countries can replace point-of-service fees with a variety of forms of sustainable financing that don’t risk putting poor people in this potentially fatal bind. Elimination or sharp reduction of point-of-service payments is a common feature of all systems that have successfully achieved universal health coverage.

Now let me tell you five specific ways the World Bank Group will support countries in their drive towards universal health coverage.

First, we’ll continue to ramp up our analytic work and support for health systems. Universal coverage is a systems challenge, and support for systems is where the World Bank Group can do the most to help countries improve the health of your people.

I was recently in Afghanistan, where the Bank Group has been working with the government and other partners to rebuild the country’s health system. In Afghanistan, this abstract term ‘health system’ quickly becomes personal. Let me tell one story. Several years ago, Shakeba, a young woman from Parwan province, gave birth at home, because there was no health center she could go to. She developed complications and lost her baby. Earlier this year, Shakeba gave birth to another child—in the delivery room of a recently-opened health center, with modern equipment and skilled personnel. Shakeba and her new baby are thriving. Improving health systems literally means life or death for many mothers and children.

The number of functioning health facilities in Afghanistan grew more than four-fold from 2002 to 2011. During this time, the country reduced under-five mortality by more than 60 percent.

Middle-income countries may face very different challenges. Many middle-income countries I visit are suffering from an epidemic of hospital-building. In some countries, I’ve seen brand-new, ultra-sophisticated emergency facilities where specialists are preparing to treat, for example, complicated emergencies like diabetic ketoacidosis. But when patients are released from these facilities, they can’t get adequate support in the routine, daily management of illnesses like diabetes, because the primary care system has been starved of financing. It makes no sense to pour resources into responding to downstream complications, without investing in upstream prevention and disease management that could often keep those complications from happening in the first place.

When countries anchor their health systems in robust primary care and public health protection, health care costs can be controlled. We will work with all countries to do just that.

Our second commitment is that we will support countries in an all-out effort to reach Millennium Development Goals 4 and 5, on maternal mortality and child mortality.

Reaching these two MDGs is a critical test of our commitment to health equity.

We must continue to focus on the MDGs, even as we prepare for the post-2015 development agenda. The MDGs have given energy and focus to everyone in the global development community. We have not finished the job. Now is the time to do it.

Last September at the United Nations General Assembly, I announced that the World Bank Group would work with donors to create a funding mechanism to scale up support for MDGs 4 and 5. Since then, we have been expanding our results-based financing for health, focusing on the maternal and child health goals. Our results-based financing fund has leveraged substantial additional resources from the International Development Association, IDA, the World Bank Group’s fund for the poorest countries. This has been an unquestioned success: the trust fund has multiplied resources for maternal and child health. Over the past five years, we have leveraged $1.2 billion of IDA in 28 countries, including $558 million for 17 countries since last September alone. Now we are working with Norway, the United Kingdom and other partners to expand this effort.

Results-based financing is a smart way to do business. It involves an up-front agreement between funders and service-providers about the expected health results. Payment depends on the delivery of outcomes, with independent verification. Results-based financing also allows citizens to hold providers accountable. It puts knowledge and power in ordinary people’s hands.

These programs all have rigorous impact evaluations. In Rwanda, the impact evaluation showed officials that performance incentives not only increased the coverage and quality of services, but also improved health outcomes. The study found that babies were putting on more weight, and that children were growing faster.

Our third commitment is that with WHO and other partners, the World Bank Group will strengthen our measurement work in areas relevant to universal health coverage. In February, the Bank and WHO agreed to collaborate on a monitoring framework for universal coverage. We’ll deliver that framework for consultation with countries by the time of the United Nations General Assembly in September.

We don’t have enough data. For example, we don’t yet measure the number of people forced into poverty by health expenditures in every country each year. We will work with countries and partners to make sure we get better data so countries can achieve better outcomes.

Fourth, we will deepen our work on what we call the science of delivery. This is a new field that the World Bank Group is helping to shape, in response to country demand. It builds on our decades of experience working with countries to improve services for poor people. As this field matures, it will mean that your frontline workers – the doctors and nurses, the managers and technicians – will have better tools and faster access to knowledge to provide better care for people.

Distinguished ministers, as you move towards universal coverage, tell us where you’re hitting barriers in delivery. We’ll connect you and your teams to global networks of policymakers and implementers who have faced similar problems. We’ll mobilize experienced experts from inside and outside the World Bank Group, including from the private sector, where much of the best delivery work happens.

Fifth and finally, the World Bank Group will continue to step up our work on improving health through action in other sectors, because we know that policies in areas such as agriculture, clean energy, education, sanitation, and women’s empowerment all greatly affect whether people lead healthy lives.

Mexico has done an impressive job in this respect. Mexico’s Seguro Popular, for instance, works in concert with the Oportunidades cash transfer program. Oportunidades has increased poor people’s spending capacity and reduced the depth of poverty. It has also raised school enrollment and access to health services among the poor. Meanwhile, Seguro Popular has reduced out-of-pocket health care payments and catastrophic health expenditures, especially for the poorest groups. All countries can’t match Mexico’s resources. But promising options for similar types of action exist for all countries.

When ministers of health seek to integrate expanded health coverage with efforts to reduce poverty, the World Bank Group’s policy advice, knowledge resources and convening power are at your disposal. For instance, we can help facilitate discussions with ministries of finance. We saw promising steps in this direction at the meeting of African health and finance ministers in Washington last month.

But specific actions from the World Bank Group must be part of a wider change in how we work together as a global health community.

The fragmentation of global health action has led to inefficiencies that many ministers here know all too well: parallel delivery structures; multiplication of monitoring systems and reporting demands; ministry officials who spend a quarter of their time managing requests from a parade of well-meaning international partners.

This fragmentation is literally killing people. Together we must take action to fix it, now.

Aligning for better results is the approach of the International Health Partnership, or IHP+. And it’s gaining momentum. Earlier today, Director-General Margaret Chan and I took part in an IHP+ meeting. It’s inspiring to see more and more countries taking charge, setting the agenda based on strong national plans, and making development partners follow the lead of governments.

We are reconfirming our shared commitment to IHP+ as the best vehicle to implement development effectiveness principles and support countries driving for results. But, honorable ministers, we must hold each other accountable. We all have to be ready to pound the table and demand that we stop the deadly fragmentation that has hindered the development of your health systems for far too long. The stakes are high and the path will be difficult, but I know we can do it.

My friends,

Together, we face a moment of decision. The question is not whether the coming decades will bring sweeping change in global health, development and the fundamental conditions of our life on this planet. The only question is what direction that change will take:

Toward climate disaster or environmental sanity;

Toward economic polarization or shared prosperity;

Toward fatal exclusion or health equity.

Change will come—it’s happening now. The issue is whether we will take charge of change: become its architects, rather than its victims. The gravest danger is that we might make decisions by default, through inaction. Instead, we must make bold commitments.

Since the turn of the millennium, we have experienced a golden age in global health, shaped by the achievements of the leaders in this hall. But will history write that the golden age expired with its hopes unfulfilled, its greatest work barely begun? That it sank under the weight of economic uncertainty and leaders’ inability to change, to push ourselves beyond our old limits?

We know what the answer must be. The answer that the peoples of all our nations are waiting for—those living today and those yet to be born.

We can do so much more. We can bend the arc of history to ensure that everyone in the world has access to affordable, quality health services in a generation.

Together, let’s build health equity and economic transformation as one single structure, a citadel to shelter the human future.

Now is the time to act.

WE MUST BE the generation that delivers universal health coverage.

WE MUST BE the generation that achieves development in the spirit of social and environmental justice.

WE MUST BE the generation that breaks down the walls of poverty’s prison, and in their place builds health, dignity and prosperity for all people.

“….15 May 2013 – The world has made dramatic progress in improving health in the poorest countries and narrowing the gaps between countries with the best and worst health status in the past two decades, according to the World Health Statistics 2013. “Intensive efforts to achieve the Millennium Development Goals have clearly improved health for people all over the world,” says Dr Margaret Chan, Director-General of WHO.

World Health Statistics 2013 contains WHO’s annual compilation of health-related data for its 194 Member States, and includes a summary of the progress made towards achieving the health-related Millennium Development Goals (MDGs) and associated targets.

This year, it also includes highlight summaries on current trends in official development assistance (ODA) for health.

Progress on the health – Available in 3 languages EnglishFrench Spanish

CHENNAI: Hidden behind 15ft-high compound walls is an 80-bed privately run home for the mentally ill in Urapakkam, 50km from the city. The home, Oxford Charitable Trust, has around 100 patients, but has not renewed its government licence for more than seven years.

“We have not issued a licence to them. They are not registered with us as a private nursing home for the mentally ill,” confirmed Dr C Jayaprakash, director of the government Institute of Mental Health (IMH). As per the law, a private mental health nursing or rehabilitation home needs a licence from the IMH or the state mental health authority. The licence has to be renewed every three years.

While there are 30 licensed private nursing homes for the mentally ill in the city, there are a number of centres that operate without licences or regulation.

Oxford Charitable Trust functions out of a white-washed building. The only entrance is a 6ft high blue gate, which is usually locked. TOI managed to gain entry into the building and found a kitchen with women cutting vegetables and stirring watery sambar. Further inside is a courtyard, surrounded by locked rooms with small windows. On the first floor are women watching television while quietly eating sambar and rice.

It could pass off for an old-age home, but residents of Urapakkam say sounds of “women shouting or crying loudly at odd hours” suggest otherwise. “They hit us if we cry, shout or try to escape,” said former inmate K Rizmiya, who has filed a petition in the Madras high court against her husband who admitted her there.

“The staff would force us to take strong sedatives at night or inject us with medicine to put us to sleep for five days if we shouted,” said Rizmiya. She protested the day she was admitted, and woke up in the same spot five days later drenched in her own urine and feces.

Oxford Charitable Trust does not fulfill the prerequisites for a mental health nursing home as per the State Mental Health Rules, 1990. “They need a psychiatrist on call and a full-time psychologist and registered social workers,” says Dr Sathyanathan, former director, IMH. “They need to have an emergency care unit and an electro-convulsive therapy facility,” he said.

The owners describe Oxford Charitable Trust as a home for the mentally ill. “We charge Rs 6,000 a month without medicines,” says one of the owners, G Ramkumar. “We take care of the patient as long as the guardians want us to.” They require a “medical history report and prescription of medicines” for admission.

Rizmiya said brokers who hang around IMH falsify medical certificates and admit people in to the home.

Guddi devi, 27: She had sought treatment for a simple stomach ache. The doctor prescribed hysterectomy. Today, with all her vitality sapped, she feels it was the biggest. Photo by Amey Mansabdar

“I feel sick.”
“I feel sick.”
“I feel sick.”
These words still echo in my ears. They did not come from a dying man or a depressed woman. They were whimpered by scores of ‘normal’ women in India‘s rural hinterlands.
The cause lay in two words uttered by their unscrupulous doctors: bacchedani kharaab. These gullible women were told their uteri were faulty, and that they had to be removed.
THE WEEK’s journey through some villages in Bihar and Rajasthan revealed the plight of women—many of them allegedly unmarried—whose wombs were removed as “treatment” for everything, from a simple stomach ache to menstrual issues.
Why? The reason, again, lay in two words: filthy lucre.

Sunita Devi, a 35-year-old labourer of Latbasepur village in Bihar’s Samastipur district, would tell us more. It all started with a debilitating stomach pain, which she had ignored for long. Thanks to the Rashtriya Swasthya Bima Yojana, she hoped to finally get proper treatment at a private hospital.
At Krishna Hospital, one of the hospitals empanelled in the rural health scheme, Sunita was told she needed an appendicitis surgery. And a hysterectomy, too.
She underwent both eight months ago. Today, she is feeble. “I often get palpitations,” she said. “I get frequent headaches and gas trouble.”
The mother of five can no longer work in the fields. She now assists at a small shop in the village. The plight of her two sisters-in-law who also underwent hysterectomies is no different.
Three years ago, the RSBY, which entitles families below poverty line to free treatment up to Rs.30,000 a year, was implemented in Samastipur district of Bihar. It was a godsend for the rural masses. But, in the hands of greedy doctors, it became a cruel instrument to siphon off public money.
The Samastipur scam came to fore when District Magistrate Kundan Kumar found an alarming number of hysterectomies conducted by private nursing homes during an RSBY meeting. Of 14,851 procedures conducted under RSBY between 2010 and 2012 in 16 empanelled hospitals in Samastipur, 5,503 were hysterectomies. That is about 37 per cent of all procedures. In some hospitals, more than 50 per cent were hysterectomies, which costs the highest of all procedures under the RSBY scheme.
Kundan Kumar organised a five-day medical camp to ascertain if the procedures conducted were needed. About 2,600 women who had undergone hysterectomy attended the camp. The expert team found 717 cases of unwanted surgery, 124 cases of underage surgery, 320 cases of fleecing and 23 cases of non-surgery.
The magistrate’s report clearly pointed to gross unethical practices. For instance, Anita Devi, 23, who complained of abdominal pain and white discharge, had been operated upon. The expert team commented: “Conservative treatment should have done, hysterectomy not justified.” Similar was the case of Ratna Devi, 40, who underwent hysterectomy for appendicitis.
The report noted that many beneficiaries mentioned by the private hospitals could not be traced. In many cases, the hospitals simply swiped their RSBY cards but never conducted the procedures. There were also instances of procedures being marked against the name of dead people. Worse, some hysterectomy ‘cases’ reportedly turned out to be men!
It was found that many of the private hospitals and nursing homes did not have the requisite infrastructure for the procedures. Only some of them had well-trained surgeons, and in a few cases, operations were conducted by non-medical practitioners.
Subsequently, 12 of 16 nursing homes in Samastipur were de-panelled from the list. FIRs, too, were lodged against five of these guilty hospitals under various sections.

Sangita devi, 26: She underwent hysterectomy two years ago. Her husband says the doctor who operated upon her often hassles her for signatures on “some paper”. Photo by Amey Mansabdar

The involved doctors, meanwhile, were doing their best to cover their tracks. “Dr Thakur from Krishna Hospital often comes to our house asking for our signature on some paper,” said the family of Sangita Devi, 26. Sangita underwent hysterectomy two years ago. Since then, she has been battling frequent spells of weakness, dizziness and headaches. She now weighs just 30kg and can hardly manage any work. She has already spent Rs.5,000 on medicine and the frequent trips to the doctors are eating away most of what her husband earns. When THE WEEK contacted, Dr Thakur refused to meet us.

Next, THE WEEK travelled to Rajasthan’sDausa district, where a high number of hysterectomies was reported recently. Guddi Devi, 27, felt sick, though she technically was not. Her bones and joints ached all day. Fatigue bound her to bed. Food did not interest her. And her eyesight was fading. It was nothing but a clear case of premature menopause, courtesy the hysterectomy and oophorectomy she underwent three years ago.
“I had gone to the doctor, complaining of stomach ache. He told me that my uterus should be removed or I would get cancer,” she said. Her family, which owns just a small piece of land, was convinced to go for the “life-saving” surgery costing Rs.16,000.
“I feel weak all the time. I constantly fall ill, and the stomach pain for which I sought treatment initially persists,” said the mother of three. She has already paid another 110,000 on treatment of these symptoms, often travelling two and a half hours by tractors and buses to the nearest hospital. Now, her 12-year-old daughter, Rinki, takes care of all the household responsibilities. “I am upset about spoiling her education,” added a sullen Guddi.

Angoori devi, 34: She underwent hysterectomy as treatment for excessive menstrual bleeding. She recalls that about 40 women were admitted along with her in the same hospital for hysterectomy. Photo by Amey Mansabda

Every village THE WEEK visited had similar stories to tell. “I went to the doctor for excessive menstrual bleeding and he advised hysterectomy,” said Angoori Devi, 34, of Sikandara. “She cannot do anything now; she gets easily tired,” complained her daughter, Guddi. The family had to sell their buffalo to pay for the surgery, which gave her joint aches, indigestion, dizziness and fatigue as companions.
“When I was admitted in the hospital, there were about 40 women who were undergoing the same operation,” Angoori recalled about her stay at Madaan Hospital. Activists in the area said as many as 2,300 women in the region have undergone unwanted hysterectomies at private hospitals in the past two years.
An RTI application filed by advocate Durga Prasad Saini of Dausa revealed that of 385 procedures conducted over six months in three private hospitals of Bandikui town in 2010, at least 226 were hysterectomies. And of them, 185 were below the age of 30.
“Is there an epidemic in Dausa that forces women to undergo hysterectomy?” asked Saini, who is also National General Secretary of Akhil Bharatiya Grahak Panchayat (ABGP). “If there was a suspicion of cancer, why was not a single biopsy done?”
What compounds the issue in such villages is the people have no one else to go to. For instance, the post of a gynaecologist had been lying vacant for many years in the community centre in Bandikui despite repeated requests.
Though the centre got a gynaecologist, it wore a dark and deserted look when we visited. “Tell us how we will manage when such a big centre only has five doctors,” said an employee. On the other hand, there are five big private hospitals in the town, doing well.
“The doctors have an understanding with the rural practitioners, who are promised a commission on referrals,” alleged Dr O.P. Bansal, who runs a hospital in Dausa. Even employees at government hospitals act as agents who take patients to private clinics.
Hysterectomy was so ubiquitous in the town that some households had three generations of women who had gone under the knife. Take the case of Sushila Devi of Maanpur village who had gone to Katta Hospital to meet a relative, Guddi Devi, admitted for hysterectomy. Sushila, too, got caught in the trap and was operated upon three days later.
Guddi Devi, a mother of four, was advised hysterectomy to cure body ache. Now, she can no longer work as a labourer. “I feel dizzy when I am in the sun, I cannot lift heavy loads and get frequent palpitations,” she said.
Surprisingly, despite protests and frequent media reports, no action was taken against erring private hospitals. “They have consent papers from the women, so we cannot do anything unless the Clinical Establishment Act is passed,” said O.P. Baherwa, chief medical and health officer, Dausa.

Vimla Devi, 20: Her caesarian section that went wrong was followed by a hysterectomy. The childless couple has filed a police case. But her husband, Mahendra Kumar, says the cops have been threatening him to not pursue the case. Photo by Amey Mansabdar

Many FIRs, too, were lodged in the local police stations against the doctors. Mahendra Kumar filed a case against Madhur Hospital and its owner Dr Rajesh Dhakar, after his 20-year-old wife, Vimla Devi, was subjected to hysterectomy following a failed caesarian section.
The crestfallen childless couple alleged that the police did not investigate the matter properly and threatened ‘action’ if Kumar pursued the case.
The attitude of officials at Dausa was, indeed, sympathetic towards the doctors. “People here attack the doctors and threaten to destroy the hospital, hoping to get compensation,” said District Collector Pramila Surana. Police Inspector Rohitash Devanda said he had not come across any cases against doctors since he took charge 10 months ago. “These people blackmail doctors to gain money. If some patients die during treatment, it does not mean the doctors are at fault,” he said. A clock bearing Madhur Hospital’s name hung on his office wall.
The RSBY triggered a uterus loot in Chhattisgarh, too. Health Minister Amar Agrawal stated that 1,800 hysterectomies were done in just eight months last year. It was estimated that at least 7,000 hysterectomies were conducted in the state over the past three years under the RSBY scheme. The issue, which was noted by the National Human Rights Commission, led to a furore and licences of 22 private hospitals were cancelled.
Down south in Andhra Pradesh, it was the state government’s insurance scheme, Arogyashri, that led to rampant exploitation. Ever since the scheme was implemented in 2007, there was an exponential rise in hysterectomy cases.
Hyderabad-based NGO Centre for Action, Research and People’s Development found that 171 women under age 40 in just one administrative block of Medak district had undergone hysterectomy. About 95 per cent of them had gone to private clinics for treatment and 33 per cent had their ovaries also removed.
A survey by the Andhra Pradesh Mahila Samatha Society found that as much as 32 per cent of about 1,000 women who underwent hysterectomy were below age 30.

These case studies and statistics point to deep rot in the health care system. In fact, it is disheartening to see a project like the RSBY—termed by the World Bank as “path-breaking”—being exploited. The RSBY was seen as a prelude to the Centre’s ambitious Universal Health Coverage, which is expected to be implemented under the 12th Five-Year Plan (2012-17).
While private health providers bring better infrastructure and quality, they also bring in the risk of greed and exploitation. Without proper monitoring, this kind of public-private partnership is a cause for concern, said Padma Deosthali, coordinator of Centre for Enquiry into Health and Allied Themes, Mumbai. “For instance, there is no mention of quality of care in the empanelment under the RSBY scheme. Not even basic standards like presence of a qualified medical practitioner and nurse,” she pointed out.
“More than treating health problems, the focus is on procedures and surgeries, which was exploited by private nursing homes,” said Dr A.V. Sahay, medical officer and district head of Bihar Swasthya Seva Sangh. He also stressed on the need for enhancing the public health care system and improving the “reproductive hygiene” of women in rural regions.
Dr Yogesh Jain of Jan Swasthya Sahyog said a major flaw in the scheme was that it did not cover out-patient treatment and, hence, encouraged unwanted hospitalisation. Without strict guidelines, doctors cannot be expected to regulate themselves, he added.
Currently, however, the Central government has directed all state nodal agencies of RSBY that approval from the insurance company concerned is mandatory for hysterectomies performed on women under age 40.
But does the issue end there? The brouhaha shall pass. The scam will turn stale. But what about the innocent women who went under the knives for no reason? Sadly, no one, except a few NGOs, has reached out to them.
“The cost of maintaining the health of a woman who had undergone hysterectomy with medicines and supplements is Rs.18,250 a year,” said Dr Prakash Vinjamuri of Hyderabad-based Life HRG, which studied the surgery’s impact on women in Medak district of Andhra Pradesh in 2011.
The toll is not just monetary. Loss of vitality and libido affects the psychological and social health of the woman. The study in Medak, for instance, found women whose uteri were removed faced domestic violence over sexual issues, and many husbands had extra-marital affairs. The worst part was the impact on the next generation, as children of these women are forced to quit school to handle household chores.
When and who will compensate for all these losses?

Vital loss

Hysterectomy is the surgical removal of the uterus but may also involve removal of the cervix. A patient may require 3-12 months for full recovery.

Early menopause
The average age of menopause in India is 51 years, and removal of ovaries advances it by 3.7 years. Menopause leads to a drop in oestrogen (female hormone) level, causing calcium loss and bone breakdown.

When is hysterectomy needed?

Hysterectomy should be a last resort in conditions such as cancers of the reproductive system, severe infections, persistent vaginal bleeding, uterine prolapse, endometriosis and to prevent further conception.

Before undergoing hysterectomy, one should undergo either a hormone test, sonography or a pap smear to test for cancer.

Today is the 16th day of Prachi’s Missing from the University College of Kurukshetra University. With Constant and deep Agony we endorse our suspicions about Prachi Kumari’s missing as under:

1. It is the 13th day of our intimating of the name, address and telephone numbers of the kidnappers but we don’t know what the police has done except dragging us to Delhi for an expensive exercise even after knowing that we maintain our works by collecting Alms (BHIKSHA) from the village peasants.

2. We suspect that either the kidnappers are torturing the girl by keeping her away from the communication system for any of their nefarious intentions or have already killed her. Because our only request to the police, just to let us meet her to see her live also in good physical and mental health was not cared yet. Instead we are being mocked at that she has already married so no need of any inquiry about her.

3. As we are a Secular Education Centre so we have all respect for freedom of thinking and freedom of choice, so if she has married to any one of any caste, color, denomination, socio-economic status, ethnic, race or even any gender we would have no problem in accepting her position or also we have no hesitation in giving her moral and any other support we are capable of. Then we don’t understand why the police are standing reluctant in making our meeting possible, if at all she is not captivated, sold for any nefarious cause or not killed?

Would the police prove fair to produce Prachi Kumari for our meeting and satisfaction of her safety and physical and mental health? The kind Principal of the University College and her class mates and the Teachers of the UC Department of Bio-Tech are also worried for she couldn’t appear in her final Practical Examination.

Kindly help us to meet her if she is married or chosen a partner to live with and if she is kept captive then kindly rescue her so that she can go back to her school and if she is at all killed by the kidnappers then kindly discover and take the action whatever is appropriate for the police and oblige.

The Human Rights Forum (HRF) demands that the government take immediate steps to ensure that the families of farmers who have committed suicide are duly compensated and rehabilitated as envisaged under GO 421. Our enquiries in Mahabubnagar district revealed that 14 farmers have committed suicide in 2012 in just one mandal i.e Bijinapally. Not a single family of these 14 farmers been compensated under GO 421. In fact, of the total farmers’ suicides of 108 reported in the entire district last year, just one family, that of D Anandam in Jangamaipally village in Ghanpur mandal (he committed suicide on 9-8-2012) been given compensation. This is an appalling state of affairs.

A six-member HRF team visited several villages in Bijinapally and Jadcherla mandals of Mahabubnagar district on Saturday (6-4-2013) to look into instances of farmers’ suicides and governmental response. The team spoke with family members of the deceased, as well as their friends and relatives. In all, we elicited facts concerning six suicides in two villages of Bijinapally mandal and one suicide in a village of Jadcherla mandal. All seven had committed suicide during last year.
All these seven farmers belonged to the small and marginal category who were driven to desperation because they had run up accumulated debts of not less than Rs 2 lakh each due to successive failure of crops, principally of cotton. Since formal credit had all but dried up over the years, their borrowings were mostly at high interest rate from the informal sector of money lenders.

HRF is of the opinion that the families of all seven deceased are eligible for the financial assistance and rehabilitation package evolved as support in such cases under G.O 421. In all these cases it can easily and clearly be established that there was “correlation between farm-related operations, economic distress and social humiliation eventually leading to suicide.”
The GO (G.O.Ms.No.421 Rev DA-II Dept., dated 1/6/2004) provides for financial assistance as an interim relief package to support such families. This assistance is in the form of an ex-gratia of Rs one lakh besides loan settlement up to a sum of Rs.50, 000 as one time settlement to creditors. This relief was intended to help in some small measure in pulling these helpless families out of acute distress.

We have no hesitation in stating that the implementation of G.O 421 in Mahbubnagar district is pathetic. For instance, in Bijinapally mandal, the three-member divisional verification and certification committee (consisting of the RDO, DSP and assistant director of agriculture) had so far not completed the requisite enquiries into these cases as is required under GO 421. In fact, the RDO-led committee has not even visited a single village and spoken with family members or other local residents to ascertain facts of the case. This is truly shocking.

Reports of these suicides have appeared prominently in the local media. In fact, three farmers of Karkonda village in Bijenapally mandal had committed suicide within a span of 12 days (from April 23, 2012 to May 4, 2012. Two of them had taken their own lives on successive days, May 3 and 4). Yet, the three-member divisional level committee has not even visited the village till date. This is insensitive and irresponsible negligence.

In fact, many months have gone by, and in several of these seven cases, over a year has gone by since the farmers committed suicide. Yet, they have not gotten any relief. This delay defeats the very purpose of G.O. 421. Not only is the government doing very little to make farming viable, it has even failed in its minimal duty of providing some succour to those families whose earning members were driven to commit suicide as a result of a severe agrarian crisis.
We urge the Collector to immediately convene a review meeting with all RDOs on the matter of implementation of G.O. 421 and ensure that the three-member divisional committees visit the villages, verifies facts and renders justice to the families of farmers who have committed suicide.